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Bot et al. Hepatoma Res 2020;6:45 Hepatoma Research
DOI: 10.20517/2394-5079.2020.62

Letter to Editor Open Access

For dietary advice in end-stage liver cirrhosis
resting metabolic rate should be measured, not
estimated

Daphne Bot , Anneke Droop , Maarten E. Tushuizen , Bart van Hoek
1
1
2
2
1 Department of Dietetics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands.
2 Department of Gastroenterology and Hepatology, and Transplantation Center, Leiden University Medical Center, Leiden 2300
RC, The Netherlands.
Correspondence to: Daphne Bot, Department of Dietetics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands.
E-mail: d.bot@lumc.nl

How to cite this article: Bot D, Droop A, Tushuizen ME, van Hoek B. For dietary advice in end-stage liver cirrhosis resting
metabolic rate should be measured, not estimated. Hepatoma Res 2020;6:45. http://dx.doi.org/10.20517/2394-5079.2020.62

Received: 24 Jun 2020 Accepted: 28 Jun 2020 Published: 10 Jul 2020
Academic Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Dear Editor,
[1]
We read with great interest the article “Frailty and Liver resection: where do we stand?” by Sioutas et al.
in Hepatoma Research. In this review, the authors summarized the available frailty tools and their impact
on postoperative outcomes in patients undergoing liver resection, in particular elderly patients (> 60 years).
In addition to this review, we would like to provide extra information regarding this topic based on own
research.

One of the variables included in most frailty assessments is nutritional status, e.g., loss of body weight or
muscle mass. It is well known that malnutrition has a negative impact on clinical outcome of patients with
end-stage liver cirrhosis. Insufficient nutrient intake, impaired digestion or absorption of nutrients, and
disturbances in macronutrient metabolism contribute to malnutrition in these patients. The total energy
expenditure consists of resting metabolic rate (RMR) and expenditure for physical activity. The Harris and
[2]
Benedict (HB) equation is widely used in clinical care for estimating RMR . However, estimating RMR with
HB may be unreliable in patients with cirrhosis. These patients can be hyper- or hypometabolic with many
individual differences in energy expenditure, especially based on disease severity and body composition.
Measuring RMR in a respiratory chamber is reliable but cumbersome . Cheaper and less complicated
[3]
devices to perform indirect calorimetry measurements have become available. We compared estimated RMR
derived with the HB equation with measured RMR using desktop indirect calorimetry in patients with end-
stage liver cirrhosis.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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